FERTILE GROUND FOR INTEGRATION
Palliative Care and Hospice Grow New Roots Together in the Healthcare Landscape
Today, home care and hospice are emerging as some of the most fertile ground on the healthcare landscape for accelerated integration to improve quality and reduce costs. According to Kimberly Skehan, RN, MSN, Senior Manager at Simione Healthcare Consultants, these mostly “out-of-hospital” care delivery models are gaining more attention from hospitals and health networks, who continue to forge ahead in developing systems of care that will accommodate every patient need and keep providers financially viable in the process.
A member of the Regulatory Committee of the National Hospice and Palliative Care Organization for 2014-15, Skehan suggests that further integration of palliative care and hospice with acute care systems will likely mean that patients get more support earlier in their disease process to facilitate a higher quality of life, and more timely and effective hospice care when it is needed. She recently presented on this topic at the May 2014 New England Home Care Conference and Trade Show in Boston.
Beyond the provision of palliative care as specialized medical care for people with serious illness and advanced or chronic disease process, new models and settings for its delivery call for more innovative ways to meet the patient’s needs and goals for care. “Palliative care can be offered simultaneously with other appropriate medical treatments in the hospital, skilled nursing facility, physician practice, home care or hospice agency or other setting,” Skehan says. “The care is typically delivered by a consultation service team in a dedicated inpatient unit, nursing home, outpatient clinic, or as part of a community-based home care or hospice program, but there are several different models emerging in the industry. It is important for providers considering development of a palliative care program to evaluate the model that works best for their organization and the healthcare environment in their region.”
Focusing on Quality
All of these delivery models pave the way for learning more about what methods work best. The National Quality Forum’s (NQF) Framework for Hospice and Palliative Care, established by the National Consensus Project as well as resources provided by the Center to Advance Palliative Care (CAPC), is reframing palliative care by making it an appropriate care choice at any age and at any stage in a serious illness, and able to be provided in conjunction with curative treatment.
“This is good news for patients and families,” says Skehan. “The goals of palliative care remain expert symptom management, coordination of care across a fragmented medical system, and practical support for patients, families and clinicians. When you couple these goals with those of hospice care, patients will benefit from an added layer of support to live comfortably for as long as possible with life-threatening illness.”
Skehan notes that the NQF Framework focuses on eight domains addressing the following aspects of care: structure and process; physical; psychological & psychiatric; social; spiritual, religious and existential; cultural; ethical & legal; and care of the patient at end of life. The NQF has endorsed and published preferred practices which correspond to these domains for providers to use as a guide toward clinical excellence in palliative care program development.
Blending Care to Support Patients
Outside of the healthcare industry, the differences between palliative care and hospice remain unclear to consumers. Hospice is a type of palliative care provided to patients near the end of life by an interdisciplinary team (for most payers there is a six-month prognosis or terminal illness limitation with requirements for admission and specific hospice benefit eligibility). “In contrast, palliative care begins at the point where life-prolonging treatment and chronic comfort care interface,” Skehan explains, “It is appropriate at any stage of serious illness, in any setting, and can be provided together with curative and other medical treatment, including hospice care.”
According to data compiled by the American Hospital Association and Center to Advance Palliative Care a growing demand for palliative care has driven the number of hospitals with palliative care programs from less than 700 in the year 2000 to more than 1,600 in the year 2010. At the same time, the National Hospice and Palliative Care Organization 2013 Facts and Figures data demonstrates that between 2008 and 2012, the number of hospice providers in the U.S. also rose by nearly 15 percent – from 4,850 to 5,560 providers. Collaboration between these two avenues of care may present many strategic opportunities for hospitals and health networks, including:
- Quality improvement initiatives for chronic disease management, hospital mortality and readmissions
- Financial benefits by helping to address proposed reimbursement changes and potential cost savings
- Regulatory benefits related to compliance with the provision of quality, patient-centered care as outlined in the NQF Framework and Joint Commission palliative care standards
- Integration to support physician engagement, ACO development and overall network efficiency
- Innovation through participation in new opportunities such as the Medicare Care Choices Model (MCCM)
Improving Care and Patient Satisfaction
The implementation of these innovative hospice and palliative care service models are designed to promote the use of palliative care sooner and in conjunction with medical treatment, and later with hospice care, to realize any potential improvements in quality of life for patients receiving both curative and palliative care. A national study will soon be under way to determine just that. With the hospice provider application deadline set for June 2014, The Medicare Care Choices Model (MCCM) will study whether access to integrated palliative and hospice care will result in improved quality of care and patient and family satisfaction, and whether there are any effects on use of curative services and the Medicare hospice benefit. The study will focus on Medicare beneficiaries who are eligible for the hospice benefit, and those who are dually eligible for traditional Medicare and the Medicaid hospice benefit, among other requirements. Over a three-year period, participation in MCCM will be limited to approximately 30,000 Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS. Study sites will include at least 30 certified hospice organizations providing care 24/7 and 365/days per year.
Skehan says, “Programs that integrate palliative and hospice care will likely connect the many loose ends that can make it challenging for patients and families. Providers who adopt these methods can create a mindful and coordinated approach that helps them stay ahead of the curve on all fronts – symptom management for the patient, quality of life in dealing with serious illness, and integrity for the operational and financial needs of their organizations working to deliver this much needed care.”